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STATION 1

You are resuscitating a newborn at birth. The baby has

gasping respiration at 30 seconds after birth.

Demonstrate what steps you would take for the next

30 seconds.

STATION 2A patient is admitted to the ICU with the following lab values:

BLOOD GASES under room air

pH: 7.199

PCO2: 32.2

HCO3: 12PO2: 86.6

ELECTROLYTES, BUN & CREATININENa: 136

K: 4Cl: 103

Ques 1 Describe metabolic condition (1)

Ques 2 Describe compensation (calculate exact compensation) (1)

Ques 3 Calculate anion gap (1)

Ques 4 Name two conditions with similar anion gap as above (1)


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STATION 2

ANSWERS

Ans 1 Metabolic acidosis with partial compensation

Ans 2 - 1 bicarb fall decreases Co2 1-1.5

Ans 3 Anion gap 25

Ans 4 Septic shock, Inborn error ( lactic acidosis), DKA etc

STATION 3

Question 1

Calculate the HR in the given ECG strip

Question 2

One box is equal to =a) 1sec, b) 0.4 second c) 0.04 second d) 0.04mm


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Question 3 - PR interval in above picture is a), b), c),d)

STATION 3

ANSWERS

1. 50 /min

If the distances are regular, count the number of "little boxes" from the

beginning of one QRS to the beginning of the next QRS complex. Divide the

number of "little boxes" (which each represent 0.04 seconds) into 1500 to

obtain the heart rate in beats per minute.

If the distances are irregular, count the number of QRS complexes, beginning at

one QRS complex to the beginning of the last QRS complex within 30 large

boxes (which each represent 0.2 seconds) and multiply by 10 to obtain the heart

rate in beats/minute.

2. c3. b

4.

a

b

c

d


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STATION 4

Q 1 Please match new unit for the older units of radiation measurement (2 marks)

OLD UNITS

1. Curie (C )

2. Rad

3. Rem

4. Roentgen (R )

NEW UNITS

a) Coulombs/kg

b) Becquerel (Bq)

c) Sievert (Sv)d) Gray (Gy)

Q 2.Black bags/bins are meant for what type of waste? (1 mark)

a. Infectious waste

b. Non-infectious waste like paper/glass

c. Organic waste like discarded food/vegetables etc

d. Both b & c

Q3. Name 4 syndromes with increased sensitivity to X-rays (2 marks)

STATION 4

Ans 1

1-b

2 -d

3 -c

4 - a

Ans 2 d

Ans 3 - Ataxia Telangectasia , Basal cell nevoid syndrome , Cockayne syndrome,Down

syndrome,Fanconi Anemia, Gardner Syndrome,Nijmegan breakage syndrome, Usher syndrome ,

Bloom syndrome


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STATION 5

DRUG - KETAMINE

Q 1. What is the dose for anesthesia for

short procedure? (1 mark)

Q2. What are the adverse effects ? ( Atleast 4) ( 2 marks)

Q3. What type of anesthesia does it cause and which part of the brain does the drug act on? ( 2 mark)

Answers STATION 5 DRUG Ketamine

Ans 1. 0.5 2 mg/kg

Ans 2 . Hypertension,tachycardia,hypotension,bradycardia,increased cerebral blood flow and intracranial

pressure,hallucination,delirium,tonic clonic movement,increased metabolic

rate,hypersalivation,nausea,vomiting, respiratory depression,apnea,increased airway resistance,cough andemergence reactions.

Ans 3 - Dissociative anesthesia and direct action on cortex and limbic system

Station 6

Counseling session

You have been called to see the parents of a child who has been

recently diagnosed as a case of Diabetes Mellitus. Kindly counsel

the parents about the disease .

(10 marks )


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Station 7

Q A. Provide ingredients and calories/100 ml and Protein/100 ml of following diet (4

marks)

1. F75

2. F100

Q B. What are the time frames for initial treatment and rehabilitation for the

management of Severe malnutrition? ( 1 mark)

Answer station 7.

1. F75- dried skim milk 25 g, sugar 70g, cereal flour 35 g, vegetable oil 27 g, mineral

mix 20 ml,vitamin MIX 140 MG, WATER TO MAKE 1000 ML . Calories 75 kcal,

protein 0.9 g

2. F75- dried skim milk 80 g, sugar 50g, vegetable oil 60 g, mineral mix 20

ml,vitamin MIX 140 MG, WATER TO MAKE 1000 ML . Calories 100 kcal, protein2.9 g

Ans B - day1-7 for initial treatment and week 2-6 for rehabilitation


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STATION 8

Q1. Write age of eruption of secondary teeth .

Q2. Write features of SMR stage 2 in girl and

SMR stage 5 in boys.

STATION 8

Ans 1. central incisor - 9-10 yr,lateral incisor 10-11 yr,canines

12-15 yr,first premolar 12-13 yr,second premolar 12-14 yr,first

molar 9-10 yr,second molar 14-16 yr,third molar 18-25 yr

Ans 2. SMR 2 girl pubic hair are sparse,lightly

pigmented,straight,medial border of labia and breast & papilla

elevated as small mound,diameter of areola increased

SMR5 in boy- pubic hair has adult distribution,spread medial

surface of thighs,penis adult size and testes adult size


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STATION 9

Give True (T) or False (F) response for the following statements

( 5 mark )

1. Cidofovir used for treatment of adenovirus infection in immunocompromised patients is a

nephrotoxic drug

2. Oseltamivir is drug of choice to treat bird-flu

3. As of Feb 2006 , Nigeria is no longer considered endemic for wild polio virus (WPV) as it had

no indigenous transmission during past 12 months

4. Dose of Varicella Zoster Immunoglobulin (V ZIG) for post exposure prophylaxis is 1 vial

(125 units) for each 10 kg increment (max 625 units) given intramuscularly as soon as possible

but within 96 hr after exposure

5. EB virus is associated with more than half the cases of mixed cellularity Hodgkins disease.

6. HMPV ( Human Metapneumovirus) was identified in 2001

7. SARS outbreak in 2003 was the 1st global epidemic of the 21st century

8. A quadrivalent HPV vaccine against types 6,11,16 and 18 has been licensed for prevention

of sqamous intraepithelial lesion

9. In case of rat bite post exposure rabies prophylaxis is not required

10. Thrombocytopenia has been reported in 10-20% of HIV +ve patients

STATION 9ANSWERS

All or True (T)


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STATION 10

HISTORY TAKING

A 9 yr old child presents to emergency department withhematemesis . Take the history of the child from mother.

STATION 12

Q 1. Regarding COLD CHAIN SYSTEM ( 2.5 marks)

1. Preserve vaccines at a temperature between +8 to 24 C True/False

2. Equipments supplied at PHC are Ice Lined Refrigerators(ILR) and

vaccine carriers True/False3. Freezers with temperature monitoring at state level ( -20 C)

True/False

4. Walk in freezers with temperature monitoring for district

level storage ( -20 C) True/False

5. The quality of Cold chain is monitored by testing Measles

vaccine samples selected randomly from the field True/False

Q 2 What is GAIN? ( 0.5 marks)

Q 3 For AFP Surveillance a rate of >1/100,000 population in

children aged less than 15 years is the best indicator for good

surveillance system . ( True/False ) 0.5 marks

Q4 Palivizumab ( monoclonal antibody) is used to treated infection with

which

virus ? 1 mark


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STATION 12

ANSWERS1. 1 false,2 true,3 false,4false,5false

2. Global alliance for Improved Nutrition

3. true

4. RSV infection in children less than 24 months with chronic lung

disease

STATION 13

Q 1 In an international clinical trial, two chemotherapy treatments are being compared.How are systematic differences between treatment groups best minimized?

a) Analyze results by country separately

b) Multivariate analysis

c) Patient Stratificationd) Prognostic factor analysis

e) Randomization

Q 2. What is the rationale for conducting a clinical trial in a double blind manner?a) It effectively increases the size of the trial by suing each patient as their own

controlb) It increases comparability of patient characteristics in the treatment and control

groups

c) It increases the precision of the estimated effect

d) It reduces systematic bias between the treatment and the control groupse) It reduces the effects of sampling variations

Q 3 In a normal distribution the mean of the data will be similar to thea) Maximum

b) Medianc) Ranged) Standard deviation

e) Standard error

Q4 The table below shows the number of adverse effects reported in a randomized trialcomparing two treatments- A and B


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The Odds Ratio of having an adverse event in group A is

a) 4/16

b) 4/20c) 4/28

d) 4/32

e) 4/60

STATION 13

ANSWERS

1.E

2.D

3.B4.C

STATION 14

Q 1 Match the appropriate antidote to its corresponding drug overdose.

(a) Deferoxamine _____ 1)Acetaminophen(b) N-Acetylcysteine ____ 2)Benzodiazepine

(c) Pyridoxine _____ 3) Nitrates/Methemoglobinemia

(d) Vitamin K _____ 4)Isoniazid

(e) BAL _____ 5) Heavy metals (mercury, gold, arsenic)

(f) Methylene blue _____ 6)Organophosphate

(g) Atropine _____ 7) Iron

TreatmentGroup

Adverse Event?

Yes No Total

A 4 28 32

B 16 12 28

Total 20 40 60


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(h) Flumazenil _____ 8) Coumarin

Q 2 List top ten causes of death worldwide of children under 5 yr of age.

STATION 14

Ans 1

A-7,B-1,C-4,D-8,E-5,F-3,G-6,H-2

Ans 2

1. LRTI

2. Diarrhoeal diseases

3. Childhood cluster diseases

4. low birth weight

5. malaria

6. birth asphyxia

7. HIV/AIDS

8. Congenital heart anomalies

9. PEM

10.STD excluding HIV

11.Drowning

12.Anenchephaly

13.Meningitis

14.RTA

15.Tuberculosis


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STATION 15

Q 1 What does the following picture show?

Q2 What are the components of 1st Trimester screen done for detection of

Downs syndrome?

STATION 15


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Answer 1 Microarray

Ans 2-using maternal age and fetal nuchal translucency (NT) thickness

along with maternal serum b-HCG,PAPP-A,unconjugated estriol and AFP

level.

STATION 16

Case Scenario

5 Year old male child presents with fever for past 10 days. Fever is high

grade, continuous in nature without chills and rigor. There is no associated

loose motions, vomiting, headache, photophobia, cough, cold or rash. Onexamination child is conscious, febrile, normotensive , conjunctival

congestion present with no apparent discharge . Two cervical lymph nodes

(Right sided) palpable, 2 cm approx each. There is desquamation of skin

around fingers. There is no hepatosplenomegaly . Rest of systemic

examination is normal.

Q 1 Your most probable diagnosis? ( 1 mark)

Q2 What characteristic feature can be found in complete blood counts?

( 1 mark)

Q 3 What is the most common cause of death in above-mentioned

patient?

( 1 mark)

Q4 What drug ( drug of choice ) you would like to give to this patient

( 1 mark)

STATION 16

Answers


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1 Kawasaki disease

2 Thrombocytosis

3 Congestive heart failure

4 Intravenous immunoglobin

STATION 17

This is a 5 minute station on volume assessment

with a normal volunteer on a couch.

Examiner: Please show me how you would assess this

patient with renal failure for volume depletion or

overload.

STATION 17

Answer

You are expected to examine the 'tissue', venous

compartment and arterial compartment signs of

volume. It would be inappropriate to ask the

volunteer questions, not just because you have been

asked to examine but also because symptoms are less

sensitive and specific than signs in this

situation.

Assess tissue signs. Check if the tongue andaxillae are moist; if they are, the patient is

unlikely to be significantly volume depleted. Check

the ankles and sacrum for oedema - its presence

would suggest that the patient either is volume

overloaded or has vascular leakage, which is

allowing salt and water to escape into the tissues.

Examine the jugular venous pressure:

visible pulsation up to 2 cm above the manubrio-

sternal angle suggests the patient is normovolaemic

if you cannot see venous pulsation, lie the patient

flat to see when it appears, and assess the degree

of central venous hypotension

if the pressure is raised, sit the patient up to

see if you can identify the highest level of


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pulsation, and assess the degree of central venous

hypertension

Examine the arterial compartment. Measure the pulse

and blood pressure with the patient lying flat.

Stand them up, then measure again after 2 minutes

standing.

STATION 18

Q 1. Indices used to distinguish between pre-

renal and established renal failure

3 Marks

Q2 Formula for Fractional excretion of Sodium

( FENa) 1 mark

Q3 What are laboratory findings in Fanconi

syndrome ? 2 marks

STATION 18

Answer 1

* a urinary sodium

* urinary osmolality

* BUN /Cr ratio

* urine osmolality/plasma osmolality

* FENa

Ans 2 urine Na x Serum Cr / serum Na x

Urine cr x 100


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Ans 3 Global tubular dysfunction - acidosis,

aminoaciduria,

glucosuria,phophaturia. Rickets

STATION 19

Question 1 Identify the condition

TWO CLINICAL PHOTOGRAPH S OF A PATIENT


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Question2 Name one association with this disease

STATION 19

Ans 1 hemihypertrophy

Ans 2 Wilms tumor, Beckweth-weildman syndrome,Sotossynmdrome

STATION 20

Q 1 Which of these is normal smear ?

Q 2 What is the noticeable difference between two smears ?

Q 3 Important points to be asked in the history on the basis of the

above abnormal smear.

Q 4 What is the next investigation of choice?

STATION 20

Answer

1. B

2. Thrombocypenia in smear A and presence of giant platelet

3. Fever/bleeding from any other site/pallor/ drug/HIV etc

4. CBC


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STATION 22

This is a 5 minute station with a normal volunteer on a couch.Examiner: This 13-year-boy has been found to have a mediastinal

mass and lymphoma is suspected. Please examine him.

STATION 23

ANSWER

Do not waffle on about 'taking a history' because your

instruction is clear and do not attempt to perform a'general' physical examination. You must use your

knowledge to focus the examination on examining:

all possible sites of lymphadenopathy: the

epitrochlear region of the elbow, neck, axillae, and

groins

the abdomen for para-aortic nodes (by deep

palpation), hepatomegaly and splenomegalythe conjunctivae for anaemia.

It is reasonable to examine the chest if you have time,

but make less of a play of this than the parts of the

examination listed above because chest examination

may well be normal, and these other features will be

much more informative, whether negative or positive.

The character and distribution of the nodes are both

important;

STATION 23


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After you have examined Patient on STATION 22

Q 1 What features of any lymph nodes found on

examination would help your differential diagnosis?

2 marks

Q2 What precautions you have to take prior to

doing any diagnostic procedure? 2 marks

Q3 What would be treatment of choice for urgent

relief of superior vena caval syndrome? 2 marks

STATION 23

Answer:

1. Matted LN- TB, Rubbery LN - Hodgkins Lymphoma

2. NO SEDATION , Procedure in sitting position not

in supine

3. Steroids with iv fluids with bicarb

STATION 24

Case scenario


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15 year old female presents with fever for past 24 hours . Fever is high

grade associated with sweating, loose motions (passed 10 large watery stools

over past 6 hours ) . For past 2 hours patient is complaining of ghabrahat ,

chakkar .

5 days back (prior to fever ) patient had her menses which were of normal

duration and normal blood loss

On examination Toxic looking, drowsy with Glasgow coma scale of 10

Blood pressure systolic 70 mm Hg , pulse rate 140 min , capillary fill time 4

seconds , RR- 30/min . There is diffuse erythematous macular rash ( sun

burn like ) all over body .

Ques 1 Probable diagnosis

Ques 2 First step in management other than airway & breathing

Ques 3 What class (targeting particular bacteria) of antibiotic you would like

to give to this patient

Ques 4 Name common predisposing factor which can cause above-

mentioned disease

Ques 5 Intravenous immunoglobin has no role to play in mentioned disease

at any level

True / false

STATION 24

Answers


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Ans 1 Toxic shock syndrome

Ans 2 Management of shock , fluid boluses

Ans 3 Anti Staphloccocal Antibiotics

Ans 4 Use of tampons or vaginal device

Ans 5 false

Answer Following questions based on Xray seen on STATION 25

a. What is abnormal in this X ray?

b. What is the ideal position of placement of umbilical arterial and umbilical venous

line?

c. After putting in a UA line, the right lower limb appears pale. What would you do?

d. What is the level of the renal artery?

e. How do you maintain a UA line?


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STATION 25

ANSWER

Abnormally placed umbilical arterial line in the subclavian artery

Abnormally high placed endotracheal tube

For umbilical arterial line - High : Between T7-T10; Low: Between L2-L3

For umbilical vein - Just above the diaphragm

Warm the other limb ; If still pale >1/2 hour, remove the UA line

L-1

Use heparin infusion at rate of 0.5-1.0 Unit per hour

STATION 27

8yr old boy presented with bleathlessness on lying supine . Had pallor +

++ with liver 4 cm , spleen 5 cm below costal margin and axillary

nodes bilateral 1x1 cm

STATION 28

Answer the following questions after seeing CXR on STATION 27


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a. What are your findings on this CXR ?

b. What is your likely diagnosis?

c. How would you confirm?

STATION 28

1. Left sided opacity with trachea shifted to right with

chest tube insitu

2. Mediastinal mass with left sided pleural effusion

cause? Lymphoma T cell3. Bone marrow in sitting position, Pleural tap and

sending cells for immunophenotyping and malignant

cells